Looking at your audiogram, it is similar to mine, but your HF falls off steeper and earlier. A difficult fit, but not unusual one. I have worn hearing aids for over 40 years and simply cannot function without them. Life is not perfect with our hearing loss, but we can function. Most difficulty is in noisy situations while one-on-one is functional with some supplemental lip reading. (Hate the mask).
I have gone from BTE to RIC and back to BTE. Most of the powerful hearing aids are BTE and the ability to keep them clean, free from wax and sweat is simpler. There are some RIC aids today where the receiver will work with your loss, but I suggest the BTE. Secondly, forget domes. You need custom ear molds to get the gain you need to hear without feedback.
I am currently using Phonak Naida M-90 SP. They make a more powerful one, UP, but it amplifies low frequency more and I don’t need that. I get them tuned, but I fine tune them myself. I do not recommend that for most people.
The key to getting the higher frequency, where speech recognition is critical, to work is frequency shifting – moving those frequencies down where your hearing is better. This is a trial and error process as the wrong settings make the speaker sound with a lisp like they are drunk. Now a good fitter aided with REM can get pretty close to the right settings, but still the last minute improvement is playing with what Phonak calls “sound recover”.
It looks like the Moment with the P receiver is close to working with your audiogram. So, try getting that receiver with custom earmolds. Then make sure you audi knows how to tune for frequency shifting. REM is an aid for that, but not the final fine tuning. If your audi can’t do that, move on.
Good luck.
What natural lows? Domes, vented or unvented, may not be able to provide you with sufficient bass. How long have you been wearing hearing aids, and have you always been in vented domes? Are your old hearing aids still functioning? If it is the case that you were unaided for decades and then only lightly aided after that, you may be more satisfied if the clinician can match what you were used to as closely as possible, rather than trying to optimize your hearing the way they might someone with different experience.
I think that is exactly what I want. It’s what I requested her to do several times in different fittings. Covid didn’t help, distance, masks in the fitting setting. I used to see the screen as my audiologist made adjustments. It was more collaborative. I don’t have open domes, basically lightly vented tulips work best. None of the Widex domes work well for me. My Resound Linx 2 sounded great for years, but eventually didn’t have the power (smaller RIC) and became unreliable.
No. I tried every brand she had. Oticon, Siemens, Widex and another. The Widex were the best but I still didn’t like them. Just too shrill and squawky. I assumed fitting adjustments would resolve that based on past experience. But it’s been almost 3 years and it hasn’t. By way of example, using my iPhone and my old Resounds via bluetooth was easy and clear. I have never in 3 years been able to use the Moments with the iPhone. The streaming speech setting is useless static noise. At this point, I will try DIY, and if I can’t get them to work for me, probably go back to my original audiologist (inconvenient location) and go back to Resounds.
Nailed it. This is exactly my past and now different current experience. The shifting isn’t being done as it had been before. I get plenty of sound that is plenty loud, it just isn’t recognizable. Going to see if I can adjust them myself (worth $150 to try) and if not, move on. Life’s too short. Custom molds are an option, but I’m reluctant to add that expense with this audi and these HAs. Maybe if DIY gets them close I will.
Good thing is you can adjust the hearing aids (like the sliders for the frequency shift) while you listen. I use the piano to fine tune harsh frequencies since I know the exact frequency of the notes. With sound recovery, I can bring clicks in the upper keys to real tones. I also hear the birds pretty good now.
Some say sound recovery is not good for musicians, but I am no longer a great musician.
What do you mean by “work best”? Work best compared to what? And has your hearing declined since you determined that tulip domes work best? Unvented domes are not more shrill than vented domes. If that’s your experience, it was a programming problem not a dome problem.
But there’s a limit to how much bass you can push into the ear with domes, regardless of the programming. The hearing aids will always sound shrill and squaky so long as the bass you need is just leaking out.
One of the most helpful things any audi said to me was, “Remember, you don’t hear like most people.” He meant I use different speech cues due to such longstanding high frequency deafness. Phonak has an algo specifically for severe loss, I have found it helpful. The other useful thing (I’m a DIY programmer) is Sound Recover 2 as a frequency shifting method BUT I roll off (turn down) the highs so they don’t make it harder for me to understand speech. That means I shift the mids but not the highs. I use HAs with vented earmolds because having some venting blocks out some background low frequency sound that would make it harder for me to hear in any background noise whatsoever. Hope this is helpful to you and it’s great to hear (well THAT is a weird turn of phrase, huh?) that you have done so well with comprehension in the face of the audiogram you have.
I became a DIY HA adjuster. I got the exact software my audiologist used along with the necessary hardware to connect the software and HAs to my laptop. To be clear, I have been trained in audio and video settings and have a good basic understanding of making decent adjustments. It took me a few days to dial my phonak p90r aids in the way I wanted them and it worked. I now have totally usable HAs.
You would think that at least so called professionals would comprehend by now and and accommodate their patients with a clear mask.
I do have residual low frequency hearing that doesn’t come through if my ear is occluded. Obviously I can’t use open fit. But “power” or unvented domes when fitted by my audi have not provided great results for me. The highs leak out even more than the lows, and I’m getting too much of the highs and not enough of the lows.
Seems like the original prescription just abandoned the 1KHz+. More recent fittings are trying to reintroduce it (perhaps with frequency compression), but he’s not used to it: hence the ‘squawky/shrill’ comments.
I’d be willing to bet that running the gain line flat across from the 750Hz value would sound fine for him. In that case, it would be around 20-25dB. I don’t think the HF targets are going to be met, but it sounds like they won’t be missed anyway.
You might be helped with cochlear implants! But take a trip to see Dr Cliff in the Phoenix area if you can afford it. You only understand the A E I O U letters
Okay, but how much gain is he really getting AT ALL with a tulip dome in that left ear; not 1000 Hz gain, but 250 Hz gain? Always hard to know over the internet, but him feeling like he hears more with a vented dome than a power dome sounds like combination of poor fit and low frequency underamplification to me.
Depends on the canal seal below 500Hz. He might ‘think’ the Tulip dome is venting, but it’s actually just folding better to his EAM shape.
He might have a tall 7x4mm oval canal, residual canal volume of half a CC and consequently a huge boost in actual SPL at the drum. That would point to why the other first fits are so errant, but the Widex is better due to the input from the Sensogram.
It’s also probably a case of habituation to his previous fitting and probably a bit of auditory deprivation too. Walking that back is going to be a long path.
Aside: We tend to think of people with this kind of loss (at least in the U.K.) with large canal volume, seeing as they’ve usually been wearing full shell moulds from pretty early on.
However; there are a few people I’ve seen recently (notably ex-Rugby players) who have over developed cartilage in the EAM. Provided you can keep the area clear of wax, it’s possible to fit them with ‘pop-in’ receivers with 5mm Sonova domes and tackle pretty hefty losses.
Scheduled Microsuction is part of the management of the fitting, but that works within our business model. This has proven effective for severe losses: though not always as bad as the one above.
Well I’ve now logged in via Compass GPS. So can confirm the low frequency under amplification. It was absurdly low. Just a big spike in the midrange, which I’ve never heard in my life. I bumped 250-1000 and will bump it more and bring the upper midrange down. Doing somewhat better now. I will screen shot the settings I had. The software has a warning 
saying likely insufficient gain.
As for fit I can’t put a medium Widex round dome in my ear. Too tight. Painful. The Widex tulips seal up quite tight. I liked the Resound tulips better with a more oval shape. So it may be as Um_bongo suggests. I can only say sone sounds are too loud.
I think that’s close to accurate. I think it went past 1000Hz but maybe not too much past. They did the frequency shifting too. I remember talking about it. I don’t think the new audi has done that. I can see in Compass she basically gave me nothing below 750, which I don’t understand. With prior audi we looked at the screen together. With the new one I never saw it, sitting 10 feet away due to Covid.
I’ve got warranty/ repair through 10/23. I’ll DIY until then, then go elsewhere.
But have you never had a custom product? An earmold?
Not with RIC HAs. I did when I had BTE, my very first pair.